Evernorth Medical Care Providers New York Professional Corporation
NPI 1205234291 · Family Medicine Physician · Melville, NY
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Evernorth Medical Care Providers New York Professional Corporation is a Family Medicine Physician organization in Melville, NY (NPI 1205234291).
Provider details
- NPI number
- 1205234291
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Jacqueline Lakes, Senior Paralegal(954) 446-0640
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Adult Medicine Physician207QA0505X
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
- Internal Medicine Physician207R00000X
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
- Podiatrist213E00000X
Podiatric Medicine & Surgery Service Providers
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
11 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Former legal business name
- Dirk Wales MD PC
- Former legal business name
- Dirk Wales MD PC
Registry dates
- Enumerated
- 2014-12-08
- Last updated
- 2025-07-14
- Certified
- 2025-07-14
Frequently asked questions
- What is Evernorth Medical Care Providers New York Professional Corporation's NPI number?
- Evernorth Medical Care Providers New York Professional Corporation's National Provider Identifier (NPI) is 1205234291, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Evernorth Medical Care Providers New York Professional Corporation?
- Evernorth Medical Care Providers New York Professional Corporation is classified in the NPPES registry as Family Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Evernorth Medical Care Providers New York Professional Corporation located?
- Evernorth Medical Care Providers New York Professional Corporation's practice location on file with NPPES is 555 Broadhollow Rd Ste 305, Melville, NY 11747-5018.
- What is Evernorth Medical Care Providers New York Professional Corporation's phone number?
- The practice phone number listed in the NPPES registry for Evernorth Medical Care Providers New York Professional Corporation is (773) 292-4800.
- Does Evernorth Medical Care Providers New York Professional Corporation accept Medicare?
- Evernorth Medical Care Providers New York Professional Corporation is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Evernorth Medical Care Providers New York Professional Corporation?
- The authorized official listed on Evernorth Medical Care Providers New York Professional Corporation's NPPES record is Jacqueline Lakes, Senior Paralegal. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Evernorth Medical Care Providers New York Professional Corporation's NPI active?
- Yes — Evernorth Medical Care Providers New York Professional Corporation's NPI (1205234291) is active in the NPPES registry as of the last update on 2025-07-14.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.